Patient Rights & Responsibilities

Clinic Info

Patient Bill of Rights

Urology PC (UPC) / Urology Surgical Center (USC) recognize the importance of respecting patient rights and adopts and affirms as departmental policy the following rights of patients who receive services from our facility, either directly or through contracted providers.

This policy affords you, the patient, the right to:

Consent to or refuse any treatment, as permitted by law – if you refuse a recommended treatment, you have the right to receive other needed and available care.

The right to know about the center rules that affect you and your treatment and about charges and payment methods.

The right to receive compassionate care that respects your personal, spiritual, cultural and religious values and beliefs.

The right to be told of realistic care alternatives when hospital care is no longer appropriate.

The right to have an advance directive, such as a living will or health care proxy. At this time, Nebraska does not have a law pertaining to advanced directives. Legal forms can be provided to you, if you so desire. However, due to the nature of an ambulatory surgery center, Urology Surgical Center does not honor Advanced Directives.

The right to privacy.

The right to be free from all forms of abuse or harassment.

The right to expect that treatment records are confidential unless you have given permission to release information or reporting is required or permitted by law.

The right to review your medical records and receive an accounting of disclosures regarding your own health information as permitted by law.

The right to know about resources, such as patient complaint and grievance processes, patient representatives that can help you promptly resolve problems and questions about your stay and care at the facility.

The right to lodge a grievance with the facility; please request a grievance form from staff involved in your care. The form may be submitted to the Urology Surgical Center Clinical Director or Administrator. You also have the right to lodge a grievance with a state or federal agency directly, regardless of whether you first use the facilities grievance process. Medicare Beneficiary Ombudsman: www.cms.hhs.gov/center/ombudsman.asp or Program Manager at 402-471-3484 or hhs.ne.gov or P.O. Box 94986, Lincoln, NE 68509-4986.

The right to receive accurate information regarding identity and professional status of those who care for you.

The right to refuse to participate in research.

The right to receive information necessary to give informed consent prior to the start of any procedure and/or treatment, except for emergencies.

The right, upon request, to receive an itemized explanation of your bill, regardless of source of payment.

The right to change provider if other qualified providers are available.

If a patient is adjudged incompetent under applicable State health and safety laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on behalf of the patient.

If a State court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

The right to receive care in a safe environment.

The right to exercise his or her rights without being subjected to discrimination or reprisal.

Patient Responsibilities

As a patient at Urology PC (UPC) / Urology Surgical Center (USC), you have the following responsibilities:

To provide UPC/USC with complete and accurate information about your past immunizations, illnesses, hospitalizations, any medications, including over the counter and dietary supplements, and any allergies or sensitivities.

To follow the treatment plan prescribed by your provider. To ask questions if you do not understand the directions or treatment being given by provider.

To provide a responsible adult to transport you home from the facility and remain with you for 24 hours, if required by the provider.

To inform your provider about any living will, medical power of attorney, or other directive that could affect your care and supply a copy of this for the UPC/USC records. However, due to the nature of an ambulatory surgery center, Urology Surgical Center does not honor Advanced Directives.

To know your insurance coverage and to accept personal financial responsibility for any charges not covered by your insurance.

To be respectful of all health care providers, staff and other patients and to respect their privacy.

To keep appointments or telephone UPC/USC within a reasonable time prior to your appointment if you need to cancel or reschedule that appointment.

Any complaints about the violation of these rights and responsibilities may be directed to the Clinical Director, Administrator, or Medical Committee Chair.